Objective Evaluation of Tubeless Thoracic Surgery in Early-Stage Lung Cancer Patients Using Multimodal Digital Device: A Prospective Study.

[BACKGROUND] Limited research has objectively assessed perioperative outcomes of tubeless thoracic surgery. This prospective study compared perioperative outcomes between tubeless and intubated surgery using a multimodal digital platform integrating a wearable device and electronic patient-reported outcomes (ePROs).

[METHODS] Of 337 patients, 263 were enrolled and instructed to wear a wearable device and complete ePROs. Propensity score matching (PSM) was applied to balance baseline characteristics.

[RESULTS] After PSM, 80 patients were included in each group. Compared with the intubation group, the tubeless group had shorter hospital length of stay (2.78 vs 3.91 days, P < .001), shorter chest tube duration (0.93 vs 2.26 days, P < .001), and lower drainage volume (128.90 vs 313.88 mL, P < .001). Wearable devices captured significant differences, with the tubeless group showing lower body temperature (36.68 °C vs 36.79 °C, P <.01) and heart rate (78.96 beats/min vs 85.23 beats/min, P < .001) on the second postoperative day. Oxygen saturation was higher in the tubeless group on postoperative day 1 (96.71% vs 95.95%, P < .001) and day 2 (96.39% vs 95.81%, P = .05). Sleep quality was better the day before (78.59 vs 75.74, P = .01) and on surgery day (85.48 vs 83.15, P < .001). ePROs reported less pain, coughing, dyspnea, and distress in the tubeless group.

[CONCLUSIONS] We validated a multimodal digital platform for perioperative assessment. Wearable-derived metrics showed modest variation, supporting feasibility rather than clinical superiority, whereas ePROs revealed differences suggesting tubeless surgery may offer a more favorable experience.